Our Summary

This research paper describes a rare medical case of a 41-year-old woman who had a long history of a pubic mass and heavy menstrual flow. She was diagnosed with uterine fibroids, a non-cancerous growth in the uterus. She underwent a surgical procedure to remove the fibroids, and the surgeons used a part of her omentum - a fatty layer of tissue in the belly - to cover the area where the growths were removed.

However, after the surgery, she developed a wound infection which led to the breakdown of the wound and partial exposure of the tissue used to cover the area. When the surgeons went back in to remove this tissue, they found it had become infarcted, meaning it had died due to lack of blood supply. She also developed an abscess, a pocket of pus, which was drained. Unfortunately, she developed another wound infection and a temporary blockage in her intestines, but these were managed without further surgery.

The authors conclude that surgeons need to be careful when using the omentum in this way, to avoid complications like these. They also suggest that surgeons should be more aware of this rare condition where the omentum can become infarcted.

FAQs

  1. What is a myomectomy and why was it performed on the patient in this case?
  2. What complications arose after the patient’s surgery and how were they managed?
  3. What precautions do the authors of the study suggest surgeons should take when using the omentum in this way?

Doctor’s Tip

A helpful tip a doctor might tell a patient about myomectomy is to carefully follow post-operative care instructions to reduce the risk of complications such as wound infections. This includes keeping the surgical site clean and dry, taking prescribed antibiotics as directed, and avoiding strenuous activities that could strain the healing tissues. It is also important to attend follow-up appointments to monitor the healing process and address any concerns promptly.

Suitable For

Myomectomy is a surgical procedure recommended for patients with uterine fibroids who wish to preserve their fertility or avoid a hysterectomy. It is typically recommended for patients who have:

  • Symptomatic fibroids causing heavy menstrual bleeding, pelvic pain, or pressure symptoms
  • Fibroids that are causing infertility or recurrent pregnancy loss
  • Fibroids that are causing urinary or bowel symptoms
  • Fibroids that are rapidly growing or causing complications such as torsion or degeneration

Patients who are not candidates for myomectomy may include those with large or multiple fibroids, severe adhesions, or significant scarring from previous surgeries. Patients with a high risk of complications during surgery, such as those with severe medical conditions, may also not be recommended for myomectomy.

In the case described above, the patient had symptomatic fibroids causing heavy menstrual bleeding, which is a common indication for myomectomy. However, she experienced rare complications during and after the surgery, highlighting the importance of careful patient selection and surgical technique in order to minimize risks and optimize outcomes for patients undergoing myomectomy.

Timeline

Before myomectomy:

  • Patient experiences symptoms such as heavy menstrual bleeding, pelvic pain, and a palpable mass in the abdomen.
  • Patient undergoes various diagnostic tests such as ultrasound, MRI, or hysteroscopy to confirm the presence of uterine fibroids.
  • Patient and healthcare provider discuss treatment options, including myomectomy as a surgical option to remove the fibroids while preserving the uterus.

After myomectomy:

  • Patient undergoes the surgical procedure to remove the fibroids, which may be performed through open abdominal surgery, laparoscopic surgery, or robotic surgery.
  • Patient may experience post-operative pain, swelling, and discomfort, which can be managed with pain medication and rest.
  • Patient is monitored closely for any signs of complications such as infection, excessive bleeding, or injury to surrounding organs.
  • Patient undergoes follow-up appointments with their healthcare provider to monitor recovery and address any concerns or complications that may arise.
  • Patient may experience improvements in symptoms such as reduced menstrual bleeding, pelvic pain, and improved quality of life following successful myomectomy.

What to Ask Your Doctor

Some questions a patient should ask their doctor about myomectomy include:

  1. What are the potential risks and complications associated with myomectomy surgery?
  2. What is the likelihood of developing a wound infection after the procedure?
  3. How will the omentum be used during the surgery, and what are the possible complications of using this tissue?
  4. What steps will be taken to prevent infections and complications during and after the surgery?
  5. What is the expected recovery time and what can I do to help facilitate healing?
  6. Are there any specific warning signs or symptoms I should watch for after the surgery?
  7. How will my pain be managed during the recovery process?
  8. Are there any long-term effects or complications that I should be aware of following the surgery?
  9. Will I need any additional procedures or treatments after the myomectomy?
  10. What are the chances of the fibroids recurring after the surgery?

Reference

Authors: Eboreime O, Yorwin G, Ohenhen V. Journal: J Med Case Rep. 2023 Jun 20;17(1):279. doi: 10.1186/s13256-023-03924-y. PMID: 37337268